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Comments Off on SAVE YOURSELF FROM NECK PAIN
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SAVE YOURSELF FROM NECK PAIN

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The neck is part of a long flexible column (the spinal column) which extends through most of the body. Spinal cord and nerves are further supported by strong ligaments and muscles that are attached to the vertebrae. Neck pain is a day-to-day complaint. Neck muscles can be strained from poor or bad posture whether it’s leaning over your computer or hunching over your workbench.

How neck pain is treated?

Neck pain treatment depends upon your diagnosis. Doctor will perform a physical exam and take your complete medical history and then refer you to specialist if necessary. Neck pain treatment may include;

  • pain medications
  • corticosteroid injections
  • muscle relaxants
  • neck collar
  • traction
  • antibiotics if you have an infection that’s causing you neck pain
  • hospital treatment or staying if a condition such as meningitis or heart attack is the cause
  • ice and heat therapy
  • exercise, stretching, and physical therapy
  • surgery which is rarely needed
  • acupuncture
  • chiropractic treatment
  • massage
  • transcutaneous electrical nerve stimulation (TENS)

The following tips can help you find neck pain relief and can work as neck pain treatment.

  • Apply ice for the first few days. Then apply heat with a heating pad, hot compress, or by taking a hot shower.
  • Take a few days off from sports and activities that aggravate your symptoms, and heavy lifting. When you resume normal activity, do as slowly as your symptoms ease.
  • Exercise your neck every day. Slowly stretch your head in up-and-down and side-to-side motions.
  • Avoid carrying heavy shoulder bags.
  • Avoid supporting the phone between your neck and shoulder.
  • Change your position often. Don’t sit or stand in one particular position for too long.
  • Get a gentle neck massage.
  • For sleeping; use a special neck pillow
  • Don’t use a neck collar without your doctor’s approval. Because if you don’t use them properly, they can make your symptoms worse.
  • Adjust your desk, chair and computer.
  • Sleep in a good position.
  • Don’t use too many pillows.

When surgery is needed

When conservative neck pain treatment does not provide relief, surgery may be needed. Surgery is generally required when;

  • Conservative therapy is not helping you
  • The patient experiences progressive neurological symptoms involving the legs and arms
  • The patient experiences difficulty with walking or balance
  • The patient is in otherwise good health condition

There are several different surgical options which can be utilized, the choice of which is influenced by the severity of each case. Other factors include patient’s age, how long someone has had the disorder, other medical conditions and if there has been previous cervical spine surgery.

Pain management institute cure acute and chronic long term pain to resume a normal life style. PMI has provided many treatments like stem cell therapy and many others.

For more details call on 815.412.6166

 

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Comments Off on ROLE OF INTRATHECAL THERAPY IN PAIN MANAGEMENT
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ROLE OF INTRATHECAL THERAPY IN PAIN MANAGEMENT

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An intrathecal pump therapy is a method of giving medication directly to your spinal cord. The therapy uses a small pump that is surgically placed under the skin of your abdomen. The pump will deliver medication through a catheter to the area around your spinal cord. Because the drug is delivered directly to the area which delivers pain signals, your symptoms can be controlled with a much smaller dose than is needed with oral medication and also reduces the side effects of medications.

Who is a candidate for intrathecal pump therapy?

You may be a candidate for intrathecal pump therapy if you meet the following criteria:

  • Conservative therapies have failed
  • You do not have benefitted from additional surgery
  • You are dependent on pain medication
  • You do not have psychological problems
  • You have no such medical conditions that would keep you from undergoing implantation
  • You are not allergic to any of the drugs used in the pump
  • You show positive response with a trial dose of medication

An intrathecal pump therapy can help to lessen chronic pain caused by:

  • Failed back surgery syndrome; failure of one or more surgeries to control persistent leg pain (sciatica), but not technical failure of the original procedure.
  • Cancer pain; persistent pain caused by tumors compressing the spinal nerves, or scarring from previous radiation therapy.
  • Reflex sympathetic dystrophy; a progressive and degenerative disease of the nervous system in which patients feel constant chronic burning pain.
  • Causalgia; a burning pain which is caused by peripheral nerve injury.
  • Arachnoiditis; painful inflammation and scarring of the meninges of the spinal nerves.
  • Chronic pancreatitis; chronic abdominal pain caused by inflammation or blockage of the pancreatic duct.

An intrathecal pump therapy can help to lessen muscle rigidity and spasms that make movement of the arms, and legs difficult caused by:

  • Cerebral palsy; a nervous disorder which impairs control of body movement.
  • Multiple sclerosis; a disorder of the brain and spinal cord caused by damage to the outer layer (myelin) of nerve cells.
  • Stroke; brain damage from lack of oxygen; due to an interrupted blood supply.
  • Brain injury
  • Spinal cord injury

 

Which medicines are using in intrathecal pump therapy?

The intrathecal pump therapy uses following medicines for pain management;

  • Baclofen
  • Bupivacaine
  • Clonidine
  • Morphine
  • Ziconotide

These medicines are delivering in this manner that intrathecal pump therapy minimize the side effects which are often associated with the higher doses used in oral or intravenous delivery of these drugs.

Procedure of the surgery

There are two parts of the intrathecal pump therapy procedure first is the placement of the catheter in the intrathecal space surrounding the spinal cord, and second is the placement of the pump/reservoir in the abdomen. There are five main steps of the procedure. The operation usually takes 3 to 4 hours.

  • Preparing the patient for the procedure
  • Catheter placement in the intrathecal space
  • Tunneling of the extension
  • Placement of the pump
  • Close the incisions

What to do after intrathecal pump therapy?

  • Take pain killers as directed by your doctor.
  • Ice your incision 3 to 4 times a day to reduce pain and swelling.
  • Do not lift heavy things for 2 weeks.
  • Do not drink alcohol for 2 weeks.
  • No strenuous activities for 2 weeks.
  • Avoid sitting for too long.
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Comments Off on Cancer pain: is there any relief
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Cancer pain: is there any relief

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Patient with cancer can feel different degrees of pain, some would have severe pain, however, some would have very mild pain and there are also those patients who do not feel pain at all. There are some cancer patients who would have achy pain. The intensity of the pain which a cancer patient bears depends on the types of cancer they have and the stage of their disease. Cancer pain management is a process in which the most needed factor is the tolerance level of the patient. If the patient has a high tolerance level, it would be easy for them as well as for the doctors to control and manage the pain. However, there are very rare cases where the patients’ of cancer have unmanageable pain.

Causes of cancer pain

There are different types and causes of cancer pain. Patients feel the most intense pain at the time of the growth of cancer. Cancer growth destroys the tissues and causes pain. Patients also have pain with the increasing size of the tumor because it keeps pressing different organs or the nerves of the patient. Patients also bear very intense pain when their tumor causes a chemical reaction in the body or the brain. Cancer itself is not the only reason for the pain cancer patients have. The treatments which cure the disease also cause pain such as radiology, chemotherapy and the surgery. Chemotherapy is the most painful treatment and its unbearable pain can even cause the death of the patient which is why doctors suggest this treatment to only those cancer patients who have strong will power to go through with the treatment safely. The doctor also considers the age and physical strength of the patients to suggest cancer treatments.

Pain management procedure for cancer

In the case of mild pain, the cancer pain management procedure depends on the pain-relieving medication. The pain-relieving medication gives short-time relaxation to the patients. Doctors mostly prescribe aspirin and ibuprofen. Doctors also suggest opioid medications but they make sure to suggest weak doses. The cancer pain-relieving medications are of different forms. There are some which patient keeps in their mouths to dissolve, however others they take in liquid form or in tablet form. To some patients, doctors give pain-relieving medication in the form of shots.

Many cancer patients for some reason do not like to accept the pain they are having so they do not get any cancer pain management procedure which makes things even more dangerous and complicated for them. Some patients do not express their pain for psychological reasons. They do not want to find out the reasons for the pain. However, at pain management institute, we make sure that our patients express the pain they are having with the accurate intensity so that we can prescribe medication. Knowing about the patients’ pain also helps doctors in deciding future treatments.

If you are a cancer patient and bearing the pain, it is maybe the right time for you to find a solution. We are here to help you out, please call us on 815-412-6174.

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Comments Off on Solution for chronic back pain found!
2018-07-10

Solution for chronic back pain found!

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Whether you have been percieving pain for two weeks or two decades,  Pain Management Institute will work with you and your insurance provider to deliver valuable treatment at the source of pain instead of highlighting the symptoms.

Below is an outline of an pioneering measure, how doees it work and the types of patients who may be candidates to make sure you understand the benefits and risks associated with the process of  Racz Epidural Neurolysis.

RACZ caudal neurolysis is an injection method which is frequently used to cure leg and back pain as a consequence of scar tissue as result of a prior surgery. This scar tissue can compress the spinal nerves and send burning pain all the way through the legs and causes unbearable pain in the lower back.

Pain Management Institute specializes in accurately diagnosing and treating the cause of painful conditions to stop them from coming back. It provides adapted treatments and integrative medicine to find the cause of your pain rather than just treating the pain symptoms.

Racz Epidural Neurolysis can evade the necessity for spinal surgery among the patients who are suffering chronic back pain and sciatic pain. This process invloves passing the Racz epidural catheter into the epidural space and injecting medicine directly at the place of nerve injury or adhesion to reduce the pain and break up adhesions generally in patients who have already had surgery.A catheter is positioned in the epidural space through which a solution of medication and local anesthetic can give profound analgesia. It is most favorable to place the epidural catheter close to the patient’s painful dermatome as possible.

The procedure is carried out with the patient lying face down with a cushion placed underneath the stomach. Back pain is intricate and has many causes. Experience of interventional pain therapy for chronic back pain has revealed that the pain is time and again due to a build up of scar tissue either from injury, disc herniation, or previous back surgery. This can be weakening, relentlessly limiting your aptitude to execute physical activity and trims down your aspiration to live your life to its fullest. The objective of the physicians and team at Pain Management Institute is to treat the source of your pain so that you can get back to living!

Prior to the procedure, your pain physician will evaluate your MRI in order to recognize which nerves are likely affected and are accountable for your pain. This injection process has the possiblity to provide instant and considerable long term liberation from chronic pain and discomfort in the lumbar spine. The process normally takes between 30 and 60 minutes. It can be done once, or in a series of up to three injections in a twelve-month period.

Taken as a whole, this method is safe. Nonetheless, with any procedure there are risks, side effects, and the possibility of complications. Luckily, the serious side effects and complications are rare. The immediate effect is generally from the local anesthetic that was injected. This effect will more often wear off in a few hours. The cortisone usually starts working in about 3 to 7 days and the effect can last for several days up to a few months.

 

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Comments Off on Why a stiff neck could leave you no good
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Why a stiff neck could leave you no good

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Up till now in a wink, everyday life became almost futile to manage for the 59 year old Lawyer from Illinoise, in United States of America

Her neck became so stiff and agonizing that she could not turn her head, which afflicted her ability to even drive safely.

“ I had to park at distant from other cars as I had so much difficulty getting in and out of the car.”, said Janice, 59 years old

She strived getting in and out of her bed and says she came to dismay going to sleep at night because of the agonizing she had to suffer

The acceleration and severity of her neck pain eventually compelled Janice to take an early withdrawal from her job.

“The final straw was when I wasn’t even able to bend to put my shoe lace and my husband had to do it for me. I decided to go to see the doctor as something wasn’t in my favor”

When she sought help, Janice was diagnosed with severe neck muscle sprains, a neck stiffening condition that causes pain and tenderness in the tendons and ligaments around the neck and shoulder. Also, there are several other causes that lead to soaring neck conditions including,

  • Cervical spinal stenosis
  • Degenerative disc disease
  • Herniated disc
  • Whiplash
  • Degenerative disc disease

Janice says: “ I was lucky that I had a physician Dr. Zaki Anwer, MD,  who understands how debilitating a neck pain could be, and Is well versed in treating neck pain,  but I have heard many stories of people who have been misdiagnosed or when they finally being diagnosed the condition worsens

“I had a bit of a catastrophe as I became hopeless to get better.” Janice then came to know the Pain Management Institute, with its potential support, advice and cooperation Janice was able to manage her everyday life better than ever

Many patients suffering from severe neck pain, initiate taking steroids too quickly without proper consultation and their body requirements and end up with the hallmarks reversed, Says Dr. Zaki Anwer, MD. In the present days newer and highly potential neck pain treatments have been introduced with lesser side effects which may include, Activity modification, Ice and/or heat therapy, Over-the-counter pain medication, Physical therapy, Manual manipulation, Massage therapy, Acupuncture, Prescription medications

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Comments Off on Is It Cold Outside? Beware Of The Winter Injuries!!

Is It Cold Outside? Beware Of The Winter Injuries!!

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With winters, there comes a lot of excitement, the preparation of snow fall, getting ready for a change of clothes that is the warmer ones, hot favorite meals; yes the very scrumptious soups, drinks, deserts, etc. And the pleasure goes on and on!!

But in the midst of all this, no one can ignore the threatening mishaps that come with the winters such as the slip and fall injuries, the broken bones, the lacerations, the severe brain injuries and what not. These all are observed as a result of the slippery surfaces that are not usually maintained. Moreover, injuries also take place because of the indoor and outdoor areas that become wet, icy and slushy and increase the risk of various slip and fall accidents.

The best thing is to opt for the preventive measures that will help protect the residents, customers, the pedestrians as well as your beloved ones from getting into any severe injury.

The Preventive Measures

Considering the injuries that can be sustained, we have elaborated here some of the preventive measures that should be followed in order to stay safe from any slip and fall injuries:

Icemelters:

Slowly and gradually, as the weather gets colder the parking lots, sidewalks, entrances and ramps are full covered in ice and give the passers-by the fullest opportunity of becoming the victims of slip and fall injury. Hence icemelters should be used that will eventually help in traction and melting the ice, thus increasing the safety levels in outdoor areas.

Matting:

If you provide your visitors the opportunity of drying off the wet on mats, then it would be a great help in preventing the slip and fall injuries. Make sure you scrap and wipe out the ice on the mats and advise your guests and visitors to do the same.

Scrubbers:

You should make the most of the floor scrubbers that will help in clearing up the route, the road or leftover slush and hence provide maximum safety. Available in a number of sizes, floor scrubbers are designed in many sizes and are also designed with ergonomics in mind which means that your back will not hurt while wiping out the floor.

Warning Signs:

Communication plays a pivotal role in preventing injuries. For instance, if you at entrance tell your aunt whose coming at night that the specific area of the floor is wet, then it would be a signal for her to walk carefully. Besides this, you can use the floor signs to warn in a best manner about dangers. In winters when the days become shorter there are chances that in the darkness, cases can be seen of slip and fall injuries. In such a situation the best way is to lit such areas so that whoever walks, notices the warning sign and thus is safe from the about-to-happen slip and fall injury.

Dr.Zaki deals greatly and expertly in the slip and fall injury cases. You are most welcome for an efficient treatment here at the Pain Management Institute. To book an appointment you may contact at (815) 464-7212.

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Comments Off on Top 4 Tips That Can Help Avoid Work Place Injuries!!

Top 4 Tips That Can Help Avoid Work Place Injuries!!

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When talking about workplace injuries, the areas that come to mind include manufacturing plants, construction sites, forestry, ice road trucking, at the office, while at a site executing a project, etc. In accordance with a latest report from the U.S. Department of Labor, it is recorded that about 3 million Americans were the victims of on the job injuries. Moreover, in regard to service providing industries, the cases that were observed were 75.5%.

Most Common Workplace Injuries Include:

Falling Object Injuries

These are the injuries that occur when something heavy, an object falls off.

Falling From Height Injuries

Sometimes the equipment is faulty or sometimes the floor is slippery due to which due to which when an employee he/she gets severely hurt.

On the Job Injuries

There can be many workplace injuries, like some are even caused by the disagreements that turn out to be very dangerous arising the fury and anger among the others.

Slipping/Trippling Injuries

As a result of slippery floors or something kept on the walking path, such as debris, cartons etc can cause the employees to stumble.

Overexertion Injuries

When you overly exert on something such as while lifting, pulling, carrying or throwing you pull your muscles and feel acute pain.

Repetitive Motion Injuries

Such type of injuries are most common at work, while typing or doing those works that become the reason of constant strain on certain body parts.

Vehicle Accidents

While performing job duties, when people get struck in an accident, they get severely injured.

Ways of preventing Workplace Injuries Include

Hiring & Training The Right People

While recruiting for your organization or your company, you must make sure that you recruit those employees that are responsible, respectful and take care of all the business processes such that no one gets injured in any unpredictable injury.

Maintain a clean work environment

When enough space for employees is reserved, then there are less chances of any walk away falls or hazardous accidents.

Create a culture of being safe

This is for the managers to take care of the fact that when the employees are sick, they should stay at home so to prevent them from any workplace mishaps that can cause severe injuries.

Clear & safety Procedures

Safety procedures should be implemented considering the employees’ health as the most important thing. Moreover, if possible and in case of any workplace injury, access should be given to the employees for appropriate safety tools and first aid.

Got stuck in a workplace accident? You are most welcome to book an appointment at  (815) 464-7212 and approach the finest treatment at Pain Management Institute.

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Comments Off on Restore Your Energy; Repair Your Joints with These 10 Remedies

Restore Your Energy; Repair Your Joints with These 10 Remedies

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They are the joints of your body that endure all kinds of stress as well as weight. From connecting your bones, providing a support to your weight and allowing you to move comfortably, these joints are fashioned in us just perfectly. Holding so much importance in our body, when these joints sometimes suffer from wear and tear, chronic pain is observed which is also known as Arthralgia.

Besides the significance in their body, there are a range of wounds such as trauma, disease, strains, sprains, bursitis, tendonitis, osteoporosis that often become the result of joint pain. Apart from these wounds, arthritis also causes severe joint pain demanding the treatment by a pain management specialist.

Normally, many cases of joint pain treatment can be sorted out at home. And in this regard, the blog highlights some remedies that if opted can prevent the pain from getting worse:

Remedies:

Ice Therapy

The time when you start experiencing joint pain, go for ice therapy. This is executed by the usage of an ice pack on the affected area for a duration of about 15 minutes. In the presence of a cold temperature the tissue swelling is reduced. While doing this you must also take care of ice burns that can occur if the ice is directly applied. Make sure it is wrapped in a towel.

Hydrotherapy

The best way to ease the pressure on the joints and muscles is to apply warm water on the affected part be it chronic pain in your knees, hips or some other body part. Massage with warm water will soothe the area and help in making the blood flow proper.

Massage Well

For proper joint pain treatment or to relieve any kind of pain, massage plays an excellent role. This can be done by a professional or you can let anyone do it at home on your affected body part. In case, yu are yourself doing it try rubbing the area with menthol. One main point to remember is that, while massaging the direction of your strokes should be towars your heart.

Medications

Most common off-the-shelf medicines that can be used in such a condition include ibuprofen, non-steroidal anti-inflammatory drugs, muscle relaxants etc.

Make the Msot of Natura Mixtures

Herbal teas, a natural herbal mixture, is a great assistance joint pain treatment as it alleviates knee, hip and other pains.

Workout Enthusiastically

It would be awesome if you exercise, but while doing you must make sure that you choose such exercises that do not over stretch your muscles leading to increased pain.

Physical Therapy

If you feel no relief on your pain, then you can also avail the option of a physical therapist who will aid you in certain movements leading pain relief.

What is the Alternative?

In case of no relief, approach a proper pain management specialist, who will after diagnosing your area of pain and its duration, will suggest the appropriate medications. In this regard, Pain Management Institute is the finest place where your joint pain will be treated in the best possible manner.

Immobilize the Area

Immobilize the affected area with a splint or a brace, that will get you rid of the acute pain or at least help in relieving pain.

Relaxing

In any kind of pain, if you relax well you will be able to defeat the fatigued condition you are facing. Moreover, if you rest in between the exercise periods then you will be able to give your body the margin to cope well and thus lessen the joint pain. Following the aforementioned tips, if you do not find any relief then its about time that you visit a pain management specialist who will guide you in terms of other remedies and medications.

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Comments Off on Do’s & Don’ts To Steer away from Accidents And Injuries

Do’s & Don’ts To Steer away from Accidents And Injuries

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Preventive Measures Are In Your Hand For Safe Driving

Car accidents are debilitating situation for every one of us, and preventing it has to be our first priority. In 2014, in Illinois fewer deaths from car accidents were reported and the number of 910 deaths from road accidents has been the lowest recorded number since 1921. The Illinois Department of Transportation has come up with a statement that fatality rate may increase in 2015. Adding to this, on 5th November, 2014, 791 deaths were reported by the department and on the same date in 2015 the department came up with reporting 835 traffic deaths. This shows that the number of traffic deaths can increase from the total number of deaths in 2014. Following are some do’s and don’ts for having a safe drive and also for avoiding any sort of slip or fall injury during winter.

·        Do Not Fully Relax At Intersection

The most important thing to avoid at the intersection is to be totally relaxed, because while entering and leaving intersection any car can be a reason of road accident. You have to drive defensively and before leaving the intersection, you have to make sure that drivers are obeying the traffic laws and you are safe.

·        Do Not Use Your Mobile Phones

Say a big “NO” to mobile phones when it comes to driving a car, as using the mobile phone may distract you from driving it safely. An Accident takes place within a second, so distraction from driving safely is not an option.

·        Do Not Get Distracted By Children In The Car

Children do not remain quiet anywhere, especially in the car as they feel very excited observing the outer environment, that is why you have to make sure that you get them engaged with anything that is able to stop them to distract you from driving safely. Giving them their favorite candies to eat while on a journey will assist you in driving attentively.

·        Keep Your Car’s Headlights On At Two-Line Roads And Highways

The reason for keeping your car’s headlights on is to remain visible when you come across dangerous driving situations. The need to keep the headlights on increases when in the foggy weather. Make sure that you hint to other drivers that you are coming through your car’s headlights on two-line roads.

·        Make Sure You Use Turn Signals

Not using turn signals is what which drivers sometimes deliberately do, as they consider it unimportant. Many accidents take place just because drivers do not use both sides’ indicators of the car during the time of turning on either side of the road and other driver behind it, is not able to react much faster to avoid collision.

Keeping in consideration the casualties that can be expected in case of an accident, such as headache, spinal injury, arm pain or fracture etc, these aforementioned tips will be a lot helpful in the long run.

Conclusion

Road accidents and slip or fall injury requires to be treated by an experienced doctor and through the treatment option that is noninvasive. For that, Pain Management Institute has its name and it is the most famous institute who caters to the victims of both car accidents and fall injuries. For booking an appointment, you can call at (815) 464-7212.

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Treating Work Injury

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The common mistake most people make is to overlook injuries and do not get the treatment as soon after getting injured. This sort of behavior, increase your chances to get many other health issues that disturbs your both professional and personal lives. In our society, there are two basic reasons behind the increased number of injuries, one is injuries inthe workplace. The most common injuries associated with these two reasons are shoulder injury, knee injury and back injury, and the most vulnerable part of your body to injury is your back. Whether you are driving or working at the workplace the most sensitive part of your body is your back and if it gets injured that take off your ability of walking, standing and sitting.

Causes of Work Injury

Some common causes for work injury are:

  • Lifting
  • Falling
  • Cutting
  • Repetitive motion

Which Workers Are More Vulnerable To Injury?

If you see overall, so everyone is vulnerable to physical injury, but workers working at the workplace are more vulnerable to injuries than others as they come across sometimes various sorts of hazardous situations while performing their duties. Following are the names of workers who have high chances of being injured at the workplace.

  • Nursing Assistants
  • Laborers
  • Heavy machinery Operators
  • Truck Drivers
  • Heavy object lifters
  • Workers working in a warehouse
  • Workers aged between 45 and 54

Many doctors say that in most workplace injury cases the culprit is overexertion and muscular, skeletal disorders account for approximately 33 percent of the cases. If you work in a physically demanding industry, then it means that you have a greater risk of getting a work related injury.

The Treatment Options For Work Injury

There are many non-invasive and nonsurgical treatment options for both sorts of injuries, and following are the most common ones.

  • Overall Medical Exam
  • Disability Evaluation
  • Functional Capacity Evaluation
  • Diagnostic Injections
  • Electromyogram (EMG)and/or Electromylogram
  • Epidural Steroid Injection
  • Medication Management
  • Neurostimulation Therapy
  • Physical Therapy
  • Therapeutic Injections

 

Conclusion

After getting an injury, the first concern for, you will be to find the right place to get your injury treated well and in this regard “Pain Management Institute” is the right place to visit. It offers you all the treatment facilities under one roof and has doctors whose experiences are unbeatable, when it comes to treat patients of both sorts of injuries. So do not waste time and get the right treatment by calling on (815) 464-7212for an appointment. We have been helping work injury patients from Frankfort, Mokena, New Lenox , Orland park, Tinley park, Chicago heights, Olympia field , Kankakee, Bourbonnais, Monee, Manhattan , Joliet, Flossmoor, Homewood , Oak lawn, Calumet city, Burr Ridge and Hinsdale.

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